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Americans feel their voice is not being heard in the healthcare debate.

With rhetoric at an all time high, as insurers fight the public option, Democrats and Republicans are more partisan than ever, and doctors and lawyers hash it out over the contribution that medical malpractice makes to rising costs, a poll by National Public Radio and the Kaiser Family Foundation finds the public feels shut out of the debate.

“71 percent told us that Congress was paying too little attention to what people like them were saying,” says Mollyanne Brodie, director of public opinion and survey research for the Kaiser Family Foundation.

National Public Radio has issued a series of audio documentary reports that diffuses the rhetoric and looks inside the very complicated issues to find some very human explanations why costs are rising higher.

Presumably, understanding of the cause can better lead to a cure.

*Editors Note: These reports are a breath of fresh air and are a must listen for everyone who has dug into a position. Sometimes the human element provides a clearer understanding of where we are, how we got here, and how best to address the future. NPR provides a much needed rest and an antidote to divisive talk that infuses some of the public airwaves.

“Moore cares for modern patients” the reporter says. That means they generally know what they want. And they ask for it.

Whether it’s an ad for the latest cure for “Restless Leg Syndrome” or nasal allergies, patients come into Dr. Moore’s office five or six times a day saying they saw an ad on television or an answer on the internet to what ails them. They request pills or diagnostic tests and believe the scant health diagnosis they've researched applies to them.

"There's a syndrome in medical school they teach us about called 'medical student syndrome,' " Moore says. When medical students learn about a disease for the first time, it's common for them to become convinced, at least temporarily, that they themselves are afflicted.

This mainly affects the younger population between the ages of 25 and 50 who have been the first audience for direct-to-consumer advertising of prescription medications that began in the mid 1980s.

Direct-to-consumer or DTC advertising of pharmaceuticals became legal in 1985 in the U.S. but began to rapidly expand in 1997 when the FDA eased regulations on the advertising of drugs. Since then, the industry has poured money into this form of promotion, spending nearly $5 billion just last year.

New Zealand is the only other country that allows DTC advertising.

How do doctors react?

Physicians looking out for the bottom line realize that they cannot only make more money but that many of these more aggressive patients will go to the next doctor to get what they want.

And there is another reason. The report gives the example from another doctor, Dr. Joseph Zebley of Baltimore, Md.

“For example, Zebley says that several times a week a patient comes in asking for a test that he is 99.99 percent sure would be a complete waste of time. But Zebley will almost always give the patient the test they request, even though he knows it will cost money and time. The main reason: malpractice.

"I'm in a position of risk if I blow them off and say, 'No, forget it, you don't have it, I'm not doing the test.' "

As a result, more medical services, drugs and surgeries are delivered than needed.

Dr. Moore says from her experience, patient demands are driving up the cost of health care by about 30 percent.

Still, she’d rather have a more informed patient who is taking an active role in their health than a passive, compliant patient. Maybe, she says, she’d like a patient who is somewhere in the middle of the two extremes.

Prescription medication spending is the third most expensive health care cost, estimated to be about $180 billion a year. The average American gets a dozen prescriptions a year.

4 Comments

Posted by JILL PAUL RNMonday, October 12, 2009 4:59 PM EST

Jane, great article. Self diagnosis by the non-professional can be a costly and dangerous situation. I agree that one should take an interest in their health care but, please leave the diagnosing and prescribing to those who have spent many years studying to become an expert in this field. A "little" knowledge is a dangerous thing.

Posted by T CopelandTuesday, October 13, 2009 3:17 PM EST

"Defensive medicine" is a hoax perpetrated by doctors and insurance companies to get their way. I'm 50 years old and neither I nor any member of my family has ever had an "unnecessary test". Further, I ask everyone who brings this up to name 1 person they personally know who has had an unnecessary test ordered by their doctor, tell me what the test was for, and was the test positivie or negative---not 1 has ever been able to state from personal knowledge that this happens. It's all because someone else (ins company, docotrs, and their allies) has said it's so. Show me the proof it happens to any significant degree or shut up about it and get on with REAL healthcare reform!

Posted by T CopelandTuesday, October 13, 2009 3:17 PM EST

"Defensive medicine" is a hoax perpetrated by doctors and insurance companies to get their way. I'm 50 years old and neither I nor any member of my family has ever had an "unnecessary test". Further, I ask everyone who brings this up to name 1 person they personally know who has had an unnecessary test ordered by their doctor, tell me what the test was for, and was the test positivie or negative---not 1 has ever been able to state from personal knowledge that this happens. It's all because someone else (ins company, docotrs, and their allies) has said it's so. Show me the proof it happens to any significant degree or shut up about it and get on with REAL healthcare reform!

So interesting that the discussions about extra testing are not usually related to doctors who test because they fear litigation (which is what insurance companies are successfully getting consumers to believe). Instead, increased costs are finally being attributed to the true source, patients who are informed (or in some cases "too" informed because of so much information being distributed by drug companies, the internet and the media).

I personally have never known a doctor (and I know a lot of them) who performed extra tests because he was afraid of future litigation. Afraid of patients, maybe, but not lawyers. Kinda goes against the mentality that most doctors have.

Thanks for this informative article.

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